| NPI | 1639302524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KY 105861) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KY 0815) |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2016-12-05 |